The American Diabetes Association’s 75th Scientific Sessions once more drew together the world’s foremost diabetes researchers and health care experts for five days of scientific presentations, discussions and analyses of the latest research surrounding this complex set of diseases. Held June 5-9 in Boston, the Scientific Sessions—the largest diabetes meeting in the world—showcased cutting-edge research on type 1 diabetes and type 2 diabetes, gestational diabetes, prediabetes and obesity, along with the risk factors for developing diabetes, new means of prevention and treatment, and the latest technology associated with managing these diseases. The meeting drew more than 18,000 participants, including nearly 15,000 clinicians, scientists and educators from all 50 states and 121 countries.
However, the real power of the Scientific Sessions is difficult to capture in simple numbers, because it lies not just in the enormous amount of information that is unveiled. It is also the unique opportunities that it provides for scientists, clinicians, health care providers and industry representatives to make important connections; between colleagues, between different research areas, and with the broader diabetes community.
At the meeting, more than 3,000 posters were arranged in a 100,000 square foot poster hall. All the researchers and their work were together in one place at one time. The attendees saw the latest progress in their specific area of interest, and in many other areas as well. They saw new approaches that they might take in their own work, and met other people working on related questions. For example, in the poster hall a beta cell researcher can see a poster on the development of materials that might work to protect cells after transplant, and at that same poster might meet an immunologist from another part of the world. Together they can all talk and realize their work is closely inter-related, and perhaps agree to work together to develop an improved platform for beta cell replacement. A clinician can attend symposia that show data on the benefits and risks of new medications that are available to treat their patients. Afterward, they might meet with old friends from medical school and discuss over dinner how they could use these new tools most effectively in practice. An established researcher can bring their whole lab to the meeting (together on a road trip, in a van!) and introduce them to the diabetes community, and lifelong professional and personal connections are made. The Scientific Sessions make all this possible, and bind together a group of dedicated people from all over the world working to change the future for people with diabetes. This reminds us all why we do what we do for people with diabetes each day.
This year was the 75th Anniversary of the American Diabetes Association, and the meeting featured special events to honor this milestone. The 75th Anniversary Display was prominently situated in the entrance hall of the convention center, and offered a visual timeline of the history of diabetes and the American Diabetes Association. It included important advances in science and clinical care, and highlights of the Association’s work over the years to improve the lives of people with diabetes. It helped to illustrate just how much progress has been made for people with diabetes since the establishment of the American Diabetes Association, and offered a preview of the things that are coming in the future.
Research highlights from select sessions from the meeting are included below:
Advances in Beta Cell Replacement Technology
Recent progress in the field of beta cell regeneration from stem cell sources has renewed confidence in the possibility of broader access to beta-cell replacement therapies, and also has sparked significant advances in the technologies that will be required to protect transplanted beta cells from the immune response and increase the life-span of these cells after transplantation. Together, these advances have also brought commercial interest in beta-cell replacement to the forefront, resulting in numerous companies investing in the translation of these advances to the clinic. Of particular interest is the work that has succeeded in producing mature, insulin secreting beta cells in large enough quantities for use in clinical application. Data presented at this year’s meeting suggested that this same methodology for producing beta cells can also produce alpha and delta cells, two cell types that normally co-exist with beta cells in the islet and help maintain glycemic control. Producing a “regenerated islet” containing all three cell types could have significant benefits compared to beta cells alone because it would preserve the regulation between the various cell types that normally occurs in a healthy pancreas. Several groups are also working on how to best encapsulate beta cells for transplantation, to protect them from the immune response, extending their functional lifespan and reducing the need for repeat transplant procedures.
The Artificial Pancreas: No Longer If, But When
The work to bring a fully automated Artificial Pancreas (AP) to reality has been ongoing for many years. This year, outpatient studies examining experimental AP technologies presented data at the conference and the results are promising, with AP control keeping subjects safely within acceptable glycemic parameters. There are several technologies being pursued, including those that provide automated insulin delivery coupled with glucose monitoring to maintain glucose control, and the bi-hormonal AP, which combines automated insulin and glucagon delivery to prevent hypoglycemia. Many questions still remain, including how to safely study the AP in children, who could be one of the greatest beneficiaries of the technology, but whom have not yet been extensively studied. However, one thing is for certain, the mood of the field has definitely shifted from wondering if an AP will make it into the clinic, to wondering when that will happen. Scientists and clinicians are now exploring not only the technology itself, but what types of education and training will need to be in place to ensure that AP technologies are integrated safely into patient care.
Brown Fat as a Target for Obesity Treatment
Work continues to determine how to leverage the energy-burning potential of brown fat. There are three types of fat cells, white fat, which primarily acts to store excess lipids; brown fat, which is derived from muscle cell precursors and burns excess lipids and glucose to produce energy (or heat); and beige fat, which is derived from the same cellular lineage as white fat, but has some of the energy burning properties of brown fat. Because both brown and beige fat have the potential to burn excess calories, there is significant interest in how to leverage them therapeutically to reduce and/or maintain weight. However, one problem associated with burning energy through activation of brown fat is that excess heat production can raise body temperature. Obviously there is a limit to how high body temperature can get before it is unsafe, limiting the amount of energy production that can be achieved through this pathway. At the meeting this year, new insights into how to increase and decrease the proportion of brown or beige fat, how to regulate its function so that it is active during periods of low metabolic activity–like at night when core body temperatures are generally lower, and how to redirect the pathway away from heat production and toward production of harmless metabolic end-products, were all discussed. From a clinical perspective, while it is still very early, characterization of this tissue type has broad implications for regulation of metabolism on many fronts and may eventually result in actionable therapeutic targets.
ELIXA and TECOS: Studies Find No Cardiac Risk or Harm from Two Diabetes Drugs
Researchers leading two major cardiovascular outcomes trials released final data demonstrating that two drugs used to lower blood glucose levels—lixisenatide (a GLP-1R agonist) and sitagliptin (a DPP-4 inhibitor)—did not increase cardiovascular risk. These two studies were performed following the FDA guidelines that call for diabetes drugs to meet stringent cardiovascular safety standards. These type of cardiovascular outcomes studies have been a requirement for new diabetes drugs since 2008, and they contribute significantly to the time and costs associated with developing therapies for diabetes. The neutral results from both the ELIXA and TECOS trials have shown that these medications are unlikely to pose excess risk for cardiovascular disease, and should provide patients and their healthcare providers some assurance when prescribing and using these therapies.
- The ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial found that treatment with lixisenatide compared to placebo did not cause any increased cardiovascular risk in 6000 high-risk patients who had recently suffered a coronary event. Although the study was designed not just to detect risk, but also to detect whether lixisenatide may have cardiovascular benefits, the study did not demonstrate any cardiovascular benefit either.
- The Trial to Evaluate Cardiovascular Outcomes After Treatment with Sitagliptin (TECOS) study, which was published concurrently with its presentation on June 8 in the New England Journal of Medicine, found no increase in the number of patients hospitalized for heart failure in 14,000 people taking sitagliptin compared to placebo.
50 Years of Diabetes Treatment and Care
From how people test their glucose levels to how long they can expect to live, almost everything has changed over the past 50 years for Americans with diabetes. On the last day of Scientific Sessions, a special symposium to commemorate the Association’s 75th Anniversary was held taking a look back at what physicians and researchers have learned and how the lives of patients have changed during the past five decades. Impatience with a chronic disease is understandable, but the symposium left all who attended with a sense of wonder in how far we have traveled, the difficulties that have been overcome along the way, and the need for basic research, serendipity, clinical translational research, education and support to carry us that next mile to improve the lives of all affected by diabetes.
- Dr. Dan Porte, Past-President of the American Diabetes Association and Banting Award recipient, described the slow, methodical process of basic science. He emphasized the importance of discovering not what we know, but what we don’t know, as the first step towards progress, and the critical part that the clinical translational scientist plays in advancing those basic discoveries. “In order to understand disease, you have to do basic research,” said Porte, a professor at the University of California, San Diego and Professor Emeritus at the University of Washington. “But you’ve got to be patient, because it takes a long time to go from basic research to clinical impact. For example, the drugs we use now to treat diabetes were first studied 30 to 40 years ago.”
- Dr. Michael Brownlee, also a Banting Award recipient, recalled how medical textbooks cited a prognosis for type 1 diabetes as “good probability of surviving into the 30s and 40s.” when he was in medical school. This wasn’t particularly reassuring to Dr. Brownlee, who had been diagnosed with type 1 diabetes at the age of 10. He has since spent his medical career studying the mechanisms of diabetic microvascular complications, because as he says, “If people with diabetes didn’t develop blindness, kidney disease and neuropathy, it would be a simple process of giving them a pill like the treatment of an under-active thyroid.” He emphasized the critical role of serendipity in landmark research findings, and cited as an example the discovery of the laser and its application to the treatment of diabetic retinopathy-which significantly reduced the occurrence of vision loss and blindness. He lauded the American Diabetes Association’s Pathway to Stop Diabetes program that supports young investigators looking for these unexpected discoveries with the potential of revolutionizing the field.
- Dr. Fred Whitehouse, Past-President of the American Diabetes Association and recipient of the Outstanding Clinician Award in 1989, began caring for people with diabetes when Benedict’s solution and urine were the only means of assessing glucose control outside of the hospital. Beef-pork insulin was administered in glass syringes with long steel needles, which needed to be sharpened and sterilized prior to each use. The major question in diabetes at that time was, “Does glucose control even matter?” As a principle investigator in the landmark Diabetes Control and Complications Trial (DCCT), Dr. Whitehouse helped to answer that question, leading to our current approach to the prevention of diabetes complications. “There are things that have happened over the past 50 years that clearly make life a lot better for people,” said Whitehouse, also Division Head Emeritus at the Henry Ford Health System in Detroit.
- Finally, in a moving and very personal presentation, Joslin medalist Ms. Kathryn Ham, on what was her 86th birthday, described her 78-year odyssey with type 1 diabetes. She talked about how she felt, not being allowed to go to school to being told she could never have children. She then went on to relay the story of her three children and her long and productive life, lived fully despite the rigors of diabetes care.
“Despite the enormous growth in our understanding of diabetes and its complications, we are still only able to manage the disease,” said Robert Ratner, MD, Chief Scientific & Medical Officer for the American Diabetes Association. “The next 50 years must elucidate the mechanisms by which both type 1 and type 2 diabetes occur, along with those critical steps at which we might intervene to prevent disease. Treatments must provide optimal glucose and metabolic control, without the risk of hypoglycemia, and complications of diabetes should become historical memories.”
76th Scientific Sessions
Save the Date!
June 10-14, 2016
Ernest N. Morial Convention Center
New Orleans, LA